Review of end-of-life care as NHS inspector warns of 'huge inequalities' in
treatment of the dying

Patients dying from dementia and heart disease are treated worse than cancer sufferers, the country’s chief inspector of hospitals has warned as he announced a national review of end-of-life care.

Prof Mike Richards said too many patients were being condemned to an “unacceptable” lottery in care, with “a huge number of inequalities” in standards of treatment - depending on where people live, which disease they develop, and where they spend their final days.

The Care Quality Commission is to hold a national review amid increasing concern that too many patients are being denied the right pain relief, end up being treated without dignity, or end up dying in hospital despite clear wishes to die in their own homes.

Prof Richards said it appeared that “cancer sufferers were getting a better deal” than those with other conditions, such as dementia, and heart disease.

Research has found that those whose relatives died from cancer were far more satisfied with the care their loved ones received, than others whose bereavement resulted from other illnesses, he said.

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Relatives of cancer sufferers were more likely to feel their loved ones had received good quality care, the right pain relief, and died in the place of their choosing, the studies have found.

Prof Richards said he was also concerned by significant geographical variations in the care received by patients, regardless of their disease.

“There are big geographic variations, but it is not as simple as a north/south divide or London versus the rest,” he said. “The south west comes out well but so does the north east... we need to understand these variations so we can improve the quality of care.”

Prof Richards, who was national clinical director for cancer and end-of-life care before he was appointed to CQC last year, said: “The level of variation is unacceptable; we need to understand why this is, in order to help the areas doing badly to do better.”

Research suggests that those who spent their dying weeks in their own homes or in hospices and in care homes, tended to have better experiences of care than those who spent much of their time in hospital.

“There was a big difference in the quality of care,” said Prof Richards. “In general, we see those in hospices getting the best care, when it comes to those who died in care homes, or in their own home, its about neck and neck, but hospitals, I regret, are some way behind.”

Plans for the national review cite recent studies which have found poor end-of-life care among dementia sufferers living in care homes.

Last year, a report by the thinktank Demos found that those with dementia, or other complex conditions, suffered worse care than those with a diagnosis of cancer.

Prof Richards said that cancer care tended to be better at providing “hospice-style” help because charities and pioneers in the field had founded such efforts decades ago.

He said future changes to improve the care of all dying patients were likely to require better use of patient records, with more sharing of information, so that the right help could be provided at all times.

He said ambulance crews should be given notice if patients had said they did not want to be sent to hospital in their dying hours.

Prof Richards said the national review, which is due to report by next March, will try to identify any “barriers to care” affecting those suffering from particular diseases, as well as those from different ethnic backgrounds, and those with mental health conditions or learning disabilities.

“This is not just about geographical variation,” he said, “It’s about examining what the barriers to good care are for all types of patients with all sorts of backgrounds or diagnoses.”

A national survey of 50,000 bereaved relatives found that those in the south west rated the care provided most highly, with those in Cornwall, Somerset, Devon and Dorset among the most positive about the way their loved ones were treated. High scores were also found in the north east, with the lowest scores found in London, and the east of England, the 2012 research found.